Super-resolution deep learning reconstruction at coronary computed tomography angiography to evaluate the coronary arteries and in-stent lumen: an initial experience.

A super-resolution deep learning reconstruction (SR-DLR) algorithm trained using data acquired on the ultrahigh spatial resolution computed tomography (UHRCT) has the potential to provide better image quality of coronary arteries on the whole-heart, single-rotation cardiac coverage on a 320-detector row CT scanner. However, the advantages of SR-DLR at coronary computed tomography angiography (CCTA) have not been fully investigated. The present study aimed to compare the image quality of the coronary arteries and in-stent lumen between SR-DLR and model-based iterative reconstruction (MBIR). We prospectively enrolled 70 patients (median age, 69 years; interquartile range [IQR], 59-75 years; 50 men) who underwent CCTA using a 320-detector row CT scanner between January and August 2022. The image noise in the ascending aorta, left atrium, and septal wall of the ventricle was measured, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the proximal coronary arteries were calculated. Of the twenty stents, stent strut thickness and luminal diameter were quantitatively evaluated. The image noise on SR-DLR was significantly lower than that on MBIR (median 22.1 HU; IQR, 19.3-24.9 HU vs. 27.4 HU; IQR, 24.2-31.2 HU, p < 0.01), whereas the SNR (median 16.3; IQR, 11.8-21.8 vs. 13.7; IQR, 9.9-18.4, p = 0.01) and CNR (median 24.4; IQR, 15.5-30.2 vs. 19.2; IQR, 14.1-23.2, p < 0.01) on SR-DLR were significantly higher than that on MBIR. Stent struts were significantly thinner (median, 0.68 mm; IQR, 0.61-0.78 mm vs. 0.81 mm; IQR, 0.72-0.96 mm, p < 0.01) and in-stent lumens were significantly larger (median, 1.84 mm; IQR, 1.65-2.26 mm vs. 1.52 mm; IQR, 1.28-2.25 mm, p < 0.01) on SR-DLR than on MBIR. Although further large-scale studies using invasive coronary angiography as the reference standard, comparative studies with UHRCT, and studies in more challenging population for CCTA are needed, this study's initial experience with SR-DLR would improve the utility of CCTA in daily clinical practice due to the better image quality of the coronary arteries and in-stent lumen at CCTA compared with conventional MBIR.

Systematic evaluation of collateral pathways to the artery of Adamkiewicz using computed tomography.

OBJECTIVES: Preoperative identification of the artery of Adamkiewicz can help prevent postoperative spinal cord injury in patients undergoing thoracic and thoraco-abdominal aortic aneurysm repair. Although several studies have shown the feasibility of evaluating the artery of Adamkiewicz using multidetector row computed tomography (MDCT), no detailed investigations regarding the collateral circulation to the artery of Adamkiewicz have been performed. The purpose of this study was to investigate the collateral circulation to the artery of Adamkiewicz using MDCT in patients with thoracic and thoraco-abdominal aortic aneurysms. METHODS: Our institutional review board approved this study. Sixty-four patients with descending thoracic and thoraco-abdominal aortic aneurysms associated with the occlusion of the segmental artery from which the artery of Adamkiewicz originated were scanned using 64- or 320-detector row computed tomography. Two independent observers evaluated the MDCT images based on the degree of visualization of the artery of Adamkiewicz and its collateral circulation using a 4-point scale. RESULTS: The average visualization score was 2.8 ± 0.6. In 53 of the 64 (83%) patients, image quality was judged to be diagnostic. MDCT demonstrated 75 collateral pathways to the artery of Adamkiewicz in these 53 patients. Sixty-four of the 75 (85%) pathways were collaterals around the spinal column, and the remaining 11 (15%) pathways were collateral arteries in the thoracic wall. CONCLUSIONS: MDCT revealed the collateral pathways to the artery of Adamkiewicz around the spinal column and in the thoracic wall in 83% of our patients with thoracic and thoraco-abdominal aortic aneurysms.

Ultra-high-resolution CT angiography of the artery of Adamkiewicz: a feasibility study.

PURPOSE: Preoperative identification of the artery of Adamkiewicz can help prevent postoperative spinal cord injury following thoracic and thoracoabdominal aortic repair. Several studies have demonstrated the feasibility of evaluating the artery of Adamkiewicz using multi-detector row computed tomography (CT), but precise visualization remains a challenge. The present study was conducted to evaluate the usefulness of ultra-high-resolution CT for visualizing the artery of Adamkiewicz with a slice thickness of 0.25 versus 0.5 mm in patients with aortic aneurysms. METHODS: Our institutional review board approved this study. Twenty-four patients with thoracic and thoracoabdominal aneurysms were scanned with beam collimation of 0.25 mm × 128. Images were reconstructed with slice thicknesses of 0.25 and 0.5 mm. The signal-to-noise ratio (SNR) of the aorta and contrast-to-noise ratio (CNR) between the anterior spinal artery and spinal cord were measured. Two independent observers evaluated visualization of the artery of Adamkiewicz and its continuity between the anterior spinal artery and the aorta using a four-point scale. RESULTS: No significant differences in the SNR of the aorta or CNR of the anterior spinal artery were observed between 0.25- and 0.5-mm slices. The average visualization score was significantly higher for 0.25-mm slices (3.58 ± 0.78) than for 0.5-mm slices (3.13 ± 0.99) (p = 0.01). The percentage of patients with nondiagnostic image quality was significantly lower for 0.25-mm slices (8.3%) than for 0.5-mm slices (33.3%) (p = 0.03). CONCLUSION: In patients with aortic aneurysms, ultra-high-resolution CT with 0.25-mm slices significantly improves visualization of the artery of Adamkiewicz compared to 0.5-mm slices.

Modified Subtraction Coronary CT Angiography Method for Patients Unable to Perform Long Breath-Holds: A Preliminary Study.

RATIONALE AND OBJECTIVES: Severe calcifications of the coronary arteries are still a major challenge in coronary computed tomography (CT) angiography (CCTA). Subtraction CCTA using a 320-detector row CT scanner has recently been introduced for patients with severe calcifications. However, the conventional subtraction CCTA method requires a long breath-holding time of approximately 20-40 seconds. This is a major problem in clinical practice because many patients may not be able to perform such a long breath-hold. We explored a modified subtraction CCTA method with a short breath-holding time to overcome this problem. MATERIALS AND METHODS: This study was approved by our institutional review board, and all patients gave written informed consent. A total of 12 patients with a coronary calcium score of >400 were enrolled in this study. All patients were unable to hold their breath for more than 20 seconds. Modified subtraction CCTA was performed using the bolus-tracking method. The acquisition protocol was adjusted so that the mask scan was acquired 10 seconds after the postcontrast scan during a single breath-hold. The subtraction image was obtained by subtracting the mask image data from the postcontrast image data. The breath-holding times were recorded. Enhancement of the coronary arteries in the subtraction images was assessed. Subjective image quality was evaluated in a total of 32 segments using a 4-point scale. RESULTS: The mean breath-holding time was 12.8 ± 0.8 seconds (range, 12-14 seconds). The average CT number in the coronary arteries was 288.6 ± 80.5 Hounsfield units (HU) in the subtraction images. Average image quality was significantly increased from 2.1 ± 0.9 with conventional CCTA to 3.1 ± 0.7 with subtraction CCTA (P < 0.001). With subtraction CCTA, the number of non-diagnostic segments was significantly reduced from 53% to 19% (P = 0.001). CONCLUSIONS: This preliminary study has shown that our modified subtraction CCTA method allows the breath-holding time to be shortened to <15 seconds. This may substantially improve the success rate of subtraction CCTA by reducing artifacts and allowing this technique to be applied to patients who are unable to perform a long breath-hold.

Diagnostic accuracy of a modified subtraction coronary CT angiography method with short breath-holding time: a feasibility study.

OBJECTIVE: To explore the feasibility and diagnostic accuracy of modified subtraction coronary CT angiography (CCTA) with short breath-holding time in patients who have limited breath-hold capability and severe coronary artery calcification. METHODS: 11 patients with a coronary calcium score >400 underwent CCTA using a modified subtraction protocol. All patients were unable to hold their breath for more than 20 s. Subjective image quality using a four-point scale and the presence of significant (>50%) luminal stenosis were assessed for each calcified or stented segment on both conventional CCTA and modified subtraction CCTA images and compared with invasive coronary angiography (ICA) as the gold standard. RESULTS: The mean breath-holding time was 13.0 ± 0.9 s. A total of 35 calcified or stented coronary segments were evaluated. The average image quality was increased from 2.1 ± 0.9 with conventional CCTA to 3.1 ± 0.7 with subtraction CCTA (p < 0.001). The segment-based diagnostic accuracy for detecting significant stenosis according to ICA revealed an area under the receiver-operating characteristic curve of 0.722 for conventional CCTA and 0.892 for subtraction CCTA (p = 0.036). CONCLUSION: Modified subtraction CCTA allows the breath-holding time to be shortened to <15 s. As compared with conventional CCTA, modified subtraction CCTA showed improvement in image quality and diagnostic accuracy in patients with limited breath-hold capability and severe calcification. ADVANCES IN KNOWLEDGE: Modified subtraction CCTA can improve the diagnostic accuracy in patients with a high calcium score and patients who are unable to perform long breath-holds.

Low-voltage quantum well microring-enhanced Mach-Zehnder modulator.

Modulation characteristics of a novel InGaAs/InAlAs multiple quantum well (MQW) microring-enhanced Mach-Zehnder modulator (MRE-MZM) is investigated in detail and its low-voltage operation with high extinction ratio is demonstrated. The MZM has a single microring resonator in one arm and is driven by the change in electrorefractive index induced by the quantum-confined Stark effect in the MQW core layer. As the MQW, a multiple five-layer asymmetric coupled quantum well (FACQW) is used to obtain a large electrorefractive index change. The driving voltage of the proposed MZM is significantly reduced owing to the enhanced phase shift in the microring resonator. High-mesa waveguide structures are grown by solid-source molecular beam epitaxy and fabricated by inductively coupled plasma etching. A directional coupler with an asymmetric branching ratio is used as an input coupler to prevent the degradation of the extinction ratio of the MZM. The extinction ratio of the fabricated MRE-MZM is approximately 27 dB. The product of the half-wave voltage and phase shifter length, V(π) · L, is 1.7 Vmm in static modulation. This value is one-quarter that of a conventional MZM with the same waveguide structure.